Author Information

Martin Holzmann,

Maria Odqvist,

Per-Ola Andersson,

Hans Tygesen and

Kai Eggers

Karolinska Institutet, Stockholm, Sweden

Background

It remains unknown how the introduction of high-sensitivity cardiac troponin T (hs-cTnT) has affected the incidence, prognosis, and use of coronary angiographies and revascularizations in patients with myocardial infarction (MI).

Methods

In a cohort study, we included all patients with a first MI from the Swedish National Patient Register 2009-2013. We used Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (CI) for risk of all-cause mortality, reinfarction, coronary angiographies, and revascularizations in MI patients diagnosed with hs-cTnT compared with those diagnosed with conventional troponins (cTn).

Results

During the study period, 47,133 MIs were diagnosed with cTn and 40,746 with hs-cTnT. The rate of MI increased by 5% (95% CI 0%-10%) after the introduction of hs-cTnT. During 3.9±2.8 years of follow-up, there were 33,492 deaths with no difference in the risk of all-cause mortality (adjusted HR 1.00, 95% CI 0.97-1.02). There were in total 15,766 reinfarctions during 3.1±2.3 years of follow-up, with an 11% reduced risk of reinfarction in patients diagnosed with hs-cTnT (adjusted HR 0.89, 95% CI 0.86-0.91). The use of coronary angiographies (adjusted HR 1.16, 95% CI 1.14-1.18) and revascularizations (adjusted HR 1.13, 95% CI 1.11-1.15) increased in the hs-cTnT group.

Conclusion

In a nationwide cohort study including 87,879 patients with a first MI, the introduction of hs-cTnT was associated with an increased incidence of MI, although with no impact on survival. We also found a reduced risk of reinfarction alongside increased use of coronary angiographies and revascularizations.

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